Provider Demographics
NPI:1619326303
Name:MAIN LINE MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:MAIN LINE MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-734-0800
Mailing Address - Street 1:303 S 69TH ST
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-4213
Mailing Address - Country:US
Mailing Address - Phone:610-734-0800
Mailing Address - Fax:610-734-1326
Practice Address - Street 1:460 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-3037
Practice Address - Country:US
Practice Address - Phone:610-734-0800
Practice Address - Fax:610-352-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0718317332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies